外科治疗成人主动脉缩窄体外循环动脉灌注方案探讨  

Discussion of Scheme of Extracorporeal Circulation Arterial Perfusion of Surgical Treatment of Adult Aortic Constriction

作　　者：彭晓鹏 朱洪玉 林明 柯略森 黄婷 王惠 Peng Xiaopeng et al(Department of Cardiovascular Surgery, Kanghua Hospital ,Dongguan 52300)

机构地区：[1]东莞康华医院心血管中心心外科,东莞523000

出　　处：《数理医药学杂志》2016年第11期1590-1592,共3页Journal of Mathematical Medicine

摘　　要：目的：探讨适用于成人主动脉缩窄外科手术体外循环动脉灌注的方式及临床疗效,为心外科体外循环灌注方式的选择提供参考。方法：选取2006年11月~2015年12月在东莞康华医院心外科接受手术治疗的成人主动脉缩窄（导管后型）的患者48例。将所选病例按照体外循环选择性动脉灌注方式的不同,分为A组深低温下半身停循环（无名动脉插管）22例和B组中度低温双侧脑保护、下半身不停循环（无名动脉动脉插管、左颈总动脉插管、股动脉插管）26例,观察并分析患者围手术期脑部症状、腹部症状、呼吸机辅助时间、肾功能及肝功能指标等变化。结果：围手术期A组死亡7例,手术成功率为68.2%;严重脑部并发症死亡4例,严重肾功能衰竭死亡3例。B组无死亡病例,手术成功率为100%。两组患者围手术期脑部症状及肾功能有显著差异;腹部症状、呼吸机辅助时间、肝功能指标等均有轻微差异。结论：外科治疗成人主动脉缩窄患者应选择最佳的体外循环动脉灌注方式,是提高手术成功率和减少围手术期脑部及肾脏等重要脏器出现并发症的重要保障,减少病死率。Objective： To investigate the application and clinical effect of extracorporeal circulation perfu- sion of adult aorta constriction surgery, which provide a reference for cardiac surgery to choose the way of extracorporeal circulation arterial perfusion.Methods：48 cases of adult patients with aortic constriction （post type） in our hospital from November 2006 to December 2015 were selected.The cases were selected. Accord- ing to the different methods of extracorporeal perfusion,The patients were divided into group A,which 22 ca- ses were under deep hypothermic and lower body circulation arrest（innominate artery intubation）,and group B,which 26 cases were medium-low temperature with bilateral cerebral protection and lower body circulation （innominate artery intubation,left common carotid artery intubation, and femoral artery intubation）.To ob- serve and analyze the changes of brain symptoms, abdominal symptoms; the auxiliary time of breathing ma- chine, renal function and liver function indexes of patients during perioperative period.Results： 7 cases died in perioperative period of A group, the success rate was 68.2~, 4cases died of severe brain complications, 3cases died of severe renal failure.There were no deaths in group B, and the success rate was 100%.There were significant differences in brain symptoms and renal function between the two groups during the periop- erative period, and there were slight differences in abdominal symptoms, auxiliary time of breathing machine and liver function indexes.Conclusion. Surgical treatment on adult aorta constriction should choose the best way of extracorporeal circulation arterial perfusion, which is the important safeguards to improve the success rate of surgery,to reduce the brain and kidney complications during perioperative period,and to decrease the I mortality rate.

关 键 词：成人 主动脉缩窄 选择性动脉灌注 股动脉插管 脑保护 

分 类 号：R543.1[医药卫生—心血管疾病]